‘We are positioned to handle complex cases in Igbobi’

Dr. Olurotomi Odunubi, the Medical Director of the National Orthopaedic Hospital Igbobi (NOHI), Igbobi, Lagos spoke to JOSEPH OKOGHENUN on challenges facing the hospital and his developmental strides in the last four years of assumption of office, even as he blamed some patients for some of the amputations that happened in the referral hospital.

How has it been as the medical director of the National Orthopaedic Hospital, Igbobi for the past four years?
It has been challenging and fulfilling. It is a government-owned hospital, fully funded from government resources and from fees paid by patients and the general drop in government revenue has affected all government parastatals. So, we have had challenges of funding from government.

The economic situation has also affected out-of-pocket payments of patients. We would have preferred a situation where patients were paying through insurance.

We equally have challenge with the falling value of the naira, just as the value of most imported drugs and equipment has gone out of hand and these have affected the cost of providing services. Part of these costs, we cannot pass to all the patients.

So, the last one year has been very terrible, because of the falling value of the naira.

But the fulfilment comes essentially from the workforce. We have a very enthusiastic workforce, who have determined in the face of all these challenges to provide services.

What are your achievements so far?
We realised in the early part of the tenure that like most modern hospitals in the world, orthopaedic medicine is too wide for doctors to practice as general orthopaedic surgeons. So, we have emphasised sub-specialisation.

We implemented the division of orthopaedic medicine into sub-specialties, in form of spine surgery, arthroplasty, paediatric orthopaedics, special trauma, arthroscopy and sport medicine.

All the consultants in the hospital are divided into these sub-specialties and they have either been trained by government or spent their money to acquire skills in these sub-specialties abroad and are providing services in these sub-specialties.

We are now positioned to be a referral centre for difficult cases from orthopaedic units and teaching hospitals and general hospitals under the state government. So, we are not really competing for the simple cases anymore.

We have made progress in orthopaedic surgery and plastic surgical unit. We have developed skills in microvascular surgery, which is the repair of vessels, arteries and veins mainly in trauma, so that the part affected and deprived of blood supply can be reconnected to blood supply, or in some cases, when the vein or artery is blocked, pathway will be created for the tissues that were affected.

We have equally infused rehabilitations services, such as in physiotherapy and occupational therapy. Some of the equipment these units have, other units in the country do not have them; hence we are better positioned to provide premium services for patients.

In clinical services, generally, we have improved in content and quality.

We have training schools that were occupational before, but are now schools offering variety of courses.

When the Federal College of Orthopaedic Technology was established, it was running a National Diploma (OND) programme in prosthetics and orthotics technology. But we have upgraded the school and it has produced its first Higher National Diploma (HND) graduands within this last four years.

The School of Orthopaedic Cast Technology has also been established and has taken its first set of students for ND programme for the 2016/2017 section.

We are still running post-basic nursing school, where we offer accident and emergency nursing and orthopaedic nursing programmes.

The residency training programme is still on course. Training is a big aspect we have improved in the last four years.

Of course, the first mandate of the hospital is research and one of the viable sources of research is the residency training programme. All the resident doctors have to engage in research project as part of their requirements for examination, which is a very good source of gathering data and presenting research information.

Our consultants are publishing their research works in reputable journals and presenting their findings in scientific conferences.

We are addressing and will keep addressing these mandates government gave to the hospital in research, clinical services and training.

How equipped is NOHI, compared to what obtains globally?
We wish that situation were better than this. But what is important is what is being done to improve on what we met on ground.

In a big hospital like this, for instance, we ready to provide services like computerised tomography (CT) scan, magnetic resonance imaging (MRI) investigations to patients.

Unfortunately, as I speak to you, patients still have to go out of the hospital for MRI and CT scans.

But the management, in its wisdom, knowing that resources are dwindling and it is not likely that government will be able to provide highly capita-intensive projects, went into private partnership with a company to build, upgrade and transfer CT and MRI. The building is ready.

The company has assured us that the CT scan equipment are in the country already. Everything will be up and doing by the end of the first quarter of this year. That is one area of deficiency that will take off in the next few months.

But in terms of laboratory, physiotherapy and occupational therapy equipment, we have upgraded a lot. But you know, all these equipment keep changing and to keep up to the changes, we need a lot of capital investments.

But what we have is an improvement of what we had four years ago.

Some people have this notion that this hospital is reputable for amputation of limbs of patients. How true is that?
We have tried to correct this notion a number of times. The truth is that no orthopaedic surgeon likes to amputate; it is a decision of last resort.

But some people get the wrong impression because they think the doctor is trying to take the easy way out. Amputation is not an easy procedure.

But most times, what happens is that at the point the orthopaedic surgeon takes a decision to amputate, it is either he will retain the limb and the patient will die or remove the limb and save the patients’ life. It is usually a decision between life and limb.

So, most patients that still come here for amputation belong to majorly two classes of patients.

One is the class of patients who have had very severe trauma. In this case, the blood supply has been cut off and the limb is already dead. The thing with a dead limb is that it will infect the living limb, thereby threatening the patient’s life and the patient can lose his life as a result.

So, you have to take a decision to remove the dead part of the patient and the patient will be alive and be useful to himself, family and society or leave him with the limb and then he would die.

The severity of the injury may be that where there is a cut and therefore there is no blood supply and limb left is not viable. You have to go for amputation.

Some time ago, there was a picture of a lady. A container fell on her leg and people had to cut the leg on the spot to save her. In that type of injury, there is no way you can make that leg that has been cut to be useful again. There is nobody anywhere in the world that can save that type of leg.

The painful ones are those that are preventable. Somebody has a simple fracture, but he is taken to traditional bonesetters, who apply a splint to the affected limb in a tight manner.

When they do that, it will cut off blood supply to the limb and when blood is not flowing to a limb, its dies. And when it dies, the only option available will be to remove the dead limb. But that was largely preventable.

Most of these fractures would have healed if they were treated well with either POP or splint. But in over-zealousness of applying a splint (by traditional bonesetters), the leg is often chocked to death and it has to be removed.

But when the removal is done, it will not be done at the traditional bonesetters’ place’ it is often done in this hospital and people outside will say ‘Igbobi Hospital cut patients’ legs.’ They won’t tell the public how the problem started.

There is also a group of patients that come to the hospital when it is too late and there is already cancer of various tissues, which can spread. The only option we may have is amputation to save the leg.